Nepal | July 14, 2020

‘Re-transplantation of kidney only after reduction of antibodies’

Sabitri Dhakal
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Kathmandu, November 4

Nephrologists have ruled out any possibility of immediate kidney re-transplantation of Prime Minister KP Sharma Oli since the level of antibodies is high in his blood.

“Kidney re-transplantation can’t be done in patients when they have high antibodies. Haemodialysis is the only option in such cases,” said Dr Santosh Gurung, Renal Transplant
Physician at Sumeru Hospital. The re-transplantation of the kidney can’t take place when the level of antibody is high. The patient needs to wait until the antibodies are removed or lessened, he added.

“As the antibodies are toxic there are high chances of a new kidney being rejected,” said Dr Kalpana Shrestha, senior consultant nephrologist and head of Nephrology Department at Shahid Dharma Bhakta National Transplant Centre.

Before transplantation, the antibodies should be removed. This can be done either by using pills, injections and/or plasmapheresis.

Plasmapheresis is a process in which unhealthy plasma (with antibodies) is taken out and fresh plasma is transfused into the patient. The process is used when injections and pills used for removing antibodies do not work properly.

Antibodies (also called immunoglobulins) are kinds of proteins that help fight against diseases. A donated kidney has protein in it. The patient’s body in which the kidney is transplanted will start producing antibodies harming the kidney he has received. Therefore, immuno-suppressant is given to the patient so that the protein released won’t harm the kidney transplanted.

Creatinine test is performed to find out whether a kidney is functioning well or not.

Creatinine is a waste product produced by muscles that is released via urine in healthy persons. Increased creatinine level in blood may mean that kidneys are not working as they should. The creatinine level should not exceed 1.4 mg/dL in males and 1.2 mg/dL in females. Haemodialysis is done when creatinine level rises above 6 mg/dL.

“If there is high creatinine level then renal biopsy is done to assure the level of antibodies in a kidney transplanted patient. Second kidney transplant is not recommended until the antibodies drop,” said Dr Rajendra Kumar Agrawal, chief consultant nephrologist.

Re-transplantation is possible only when there is proper dialysis, medication and normal health condition of the patient. It could take at least three months,” added Agrawal.

The transplanted kidney stops functioning because of the antibodies produced, side effects of the medicines the patient is consuming after transplantation; kidneys get affected because of increased number of dialysis, and severe infections, added Gurung.

If the antibodies are not removed then haemodialysis is the only option for the patient. The patient will have to undergo haemodialysis thrice a week. Depending upon his/her health condition, haemodialysis can be done twice a week. Each session of haemodialysis is completed in four hours, Shrestha added.

For a re-transplantation, the cause for failure of the first transplanted kidney should be detected. The outcome of re-transplantation is not so effective compared to the first transplant, the doctors said.

The PM was admitted to Grande International Hospital on Wednesday where he underwent two rounds of haemodialysis before being discharged on Thursday. The hospital said dialysis was conducted to lower the increased level of creatinine.


A version of this article appears in print on November 05, 2019 of The Himalayan Times.

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